Provider Demographics
NPI:1124029657
Name:LEADBITTER, GILBERT E (DC)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:E
Last Name:LEADBITTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:GILBERT
Other - Middle Name:E
Other - Last Name:LEADBITTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:104 ROUTE 837
Mailing Address - Street 2:
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063-1034
Mailing Address - Country:US
Mailing Address - Phone:724-258-9565
Mailing Address - Fax:724-258-9036
Practice Address - Street 1:104 ROUTE 837
Practice Address - Street 2:
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063-1034
Practice Address - Country:US
Practice Address - Phone:724-258-9565
Practice Address - Fax:724-258-9036
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005259L111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU56649Medicare UPIN
PALE048962Medicare ID - Type UnspecifiedMEDICARE